Water/cortical bone decomposition: A new approach in dual energy CT imaging for bone marrow oedema detection. A feasibility study

Biondi, M.; Vanzi, E.; Otto, G. De; Buonamici, F. Banci; Belmonte, Giuseppe; Mazzoni, Lorenzo Nicola; Guasti, A.; Carbone, Salvatore Francesco; Mazzei, Maria Antonietta; Penna, A. La; Foderà, E.; Guerreri, D.; Maiolino, Ângelo; Volterrani, Luca

doi:10.1016/j.ejmp.2016.08.004

Cited by 22 publications

(16 citation statements)

References 13 publications

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“…However, visualization of bone marrow edema at conventional single-energy CT is severely hampered by the dense trabecular structure of the cancellous bone (22,23). Advances in dual-energy CT have enabled the direct visualization of bone marrow abnormalities through creation of virtual noncalcium (VNCa) images (18,(24)(25)(26)(27)(28)(29)(30). Previous investigators have used this method to image the extremities and the spine (1,13,18,24,(31)(32)(33)(34).…”

Section: Study Populationmentioning

confidence: 99%

Vertebral Compression Fractures: Third-Generation Dual-Energy CT for Detection of Bone Marrow Edema at Visual and Quantitative Analyses

et al. 2017

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Purpose To assess the diagnostic performance of a third-generation dual-energy computed tomographic (CT) virtual noncalcium (VNCa) technique for detection of traumatic bone marrow edema in patients with vertebral compression fractures. Materials and Methods This prospective study was approved by the institutional review board. Informed consent was obtained from all participants. Twenty-two consecutive patients with 37 morphologic vertebral fractures were studied between October 2015 and May 2016. All patients underwent dual-energy CT (90 kV and 150 kV with a tin filter) and 3-T magnetic resonance (MR) imaging. Two independent readers visually evaluated all vertebral bodies (n = 163) for the presence of abnormal bone marrow attenuation on VNCa images by using color-coded maps and performed a quantitative analysis of CT numbers on VNCa images. MR images served as the reference standard. CT numbers were subjected to receiver operating characteristic analysis to calculate cutoff values. Results In the visual analysis, VNCa images had an overall sensitivity of 64.0%, specificity of 99.3%, accuracy of 93.9%, positive predictive value of 94.1%, and negative predictive value of 93.8%. The interobserver agreement was excellent (κ = 0.85). CT numbers obtained from VNCa images were significantly different in vertebral bodies with and without edema (P < .001). Receiver operating characteristic analysis revealed an area under the curve of 0.922. A cutoff value of -47 provided sensitivity of 92.0%, specificity of 82.6%, accuracy of 84.0%, positive predictive value of 48.9%, and negative predictive value of 98.3% for the differentiation of edematous vertebral bodies. Conclusion Visual and quantitative analyses of dual-energy VNCa images showed excellent diagnostic performance for assessing traumatic bone marrow edema in vertebral compression fractures. RSNA, 2017 Online supplemental material is available for this article.

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Section: Study Populationmentioning

confidence: 99%

Vertebral Compression Fractures: Third-Generation Dual-Energy CT for Detection of Bone Marrow Edema at Visual and Quantitative Analyses

et al. 2017

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“…Previous studies evaluated DECT accuracy based on radiologist scoring of EMSI presence in predefined anatomical regions within the knee. 10,11,13,17,19,20 Results varied, with some reporting excellent diagnostic accuracy (sensitivity: 86%-94%, specificity: 94%-95%), 11,13 whereas others found a more moderate sensitivity of 70% and specificity of 69%. 20 The quantitative, voxel-by-voxel comparison between DECT and MRI in the current study provides measurement of location-specific segmentation accuracy (dice coefficient), as well as comparison of intensity correlation (cross-correlation) and shared information (mutual information) between DECT and gold-standard MRI.…”

Section: Discussionmentioning

confidence: 99%

“…9 This technique of subtracting out the calcium component of the CT signal has been applied successfully to image EMSI associated with several musculoskeletal pathologies, including acute knee injury and vertebral and hip fractures. [10][11][12][13][14][15] Although CT has the drawback of introducing ionizing radiation, recent technical improvements have substantially lowered the radiation dose and risk associated with CT imaging, 16 and it has been shown that EMSI can be detected using DECT at similar radiation doses to single energy CT. 17 DECT-based identification of EMSI depends on the selection of appropriate image analysis parameters. In particular, the decomposition of images into a base set of constituent materials requires, as input, the attenuation of each basis material at the two energy levels at which the scan is performed.…”

Section: Introductionmentioning

confidence: 99%

“…Qualitative comparison of EMSI visualized using these DECT methods with gold-standard MRI has shown excellent agreement between the two modalities. 10,11,13,17,19 However, the precise impact of the parameters selected for image analysis, including attenuation values for basis materials, material decomposition technique, and threshold values, on the DECT result, are not well understood.…”

Section: Introductionmentioning

confidence: 99%

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A quantitative assessment of dual energy computed tomography‐based material decomposition for imaging bone marrow edema associated with acute knee injury

et al. 2021

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This study developed methods to quantify and improve the accuracy of dual-energy CT (DECT)-based bone marrow edema imaging using a clinical CT system. Objectives were: (a) to quantitatively compare DECT with gold-standard, fluid-sensitive MRI for imaging of edema-like marrow signal intensity (EMSI) and (b) to identify image analysis parameters that improve delineation of EMSI associated with acute knee injury on DECT images. Methods: DECT images from ten participants with acute knee injury were decomposed into estimated fractions of bone, healthy marrow, and edema based on energy-dependent differences in tissue attenuation. Fluid-sensitive MR images were registered to DECT for quantitative, voxel-by-voxel comparison between the two modalities. An optimization scheme was developed to find attenuation coefficients for healthy marrow and edema that improved EMSI delineation, compared to MRI. DECT method accuracy was evaluated by measuring dice coefficients, mutual information, and normalized cross correlation between the DECT result and registered MRI. Results: When applying the optimized three-material decomposition method, dice coefficients for EMSI identified through DECT vs MRI were 0.32 at the tibia and 0.13 at the femur. Optimization of attenuation coefficients improved dice coefficient, mutual information, and cross-correlation between DECT and gold-standard MRI by 48%-107% compared to three-material decomposition using nonoptimized parameters, and improved mutual information and cross-correlation by 39%-58% compared to the manufacturer-provided two-material decomposition. Conclusions: This study quantitatively evaluated the performance of DECT in imaging knee injuryassociated EMSI and identified a method to optimize DECT-based visualization of complex tissues (marrow and edema) whose attenuation parameters cannot be easily characterized. Further studies are needed to improve DECT-based EMSI imaging at the femur.

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“…Finally, we cannot exclude false negative cases of early SI on CTE since bone marrow edema cannot be detected through this imaging modality. With regard to the latter observation, a mention should be made of the potential use of the dual energy (DE) technique for CT-enterography, considering its benefits in terms of better visualization of affected hypervascular bowel walls in CD using virtual monoenergetic images at low keV and of bone marrow edema using material decomposition algorithms [68][69][70][71].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology

Mazzei

Gentili

Guerrini

et al. 2020

Gastroenterology Insights

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Purpose: The purpose of this study was to evaluate the prevalence and the underreporting rate of sacroiliitis (SI) in a large cohort of patients with biopsy-proved Crohn’s disease (CD) who underwent magnetic resonance enterography (MRE) or computed tomography enterography (CTE). Materials and Methods: Patients with CD were recruited from eight Italian health centers in the period from January 2013 to December 2017. Disease activity was recorded according to the CD activity index (CDAI). The scans were read by two blinded readers who defined the presence of SI according to Assessment of SpondyloArthritis International Society (ASAS) classifications and European League Against Rheumatism (EULAR) recommendations. Moreover, SI was scored using a simplified Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. Results: Interobserver agreement in diagnosing SI on imaging was good (K = 0.72–0.83). SI was diagnosed in 129 (14.4%, 54 men, 75 women) out of 894 patients; however, sacroiliac joint (SIJ) abnormalities were not mentioned in the radiological reports of 112 patients (86%). Fifty (38.7%) out of 129 patients also underwent a subsequent SIJ evaluation through a dedicated MRI protocol to confirm SI. SI was found in a higher percentage of patients with “active” than “inactive” CD (18% vs. 4%). Conclusion: This study confirms the feasibility of CTE and MRE for the screening of SI in CD patients; however, it also underlines the remarkable problem concerning the underreporting of this entity in radiological practice.

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Water/cortical bone decomposition: A new approach in dual energy CT imaging for bone marrow oedema detection. A feasibility study

Cited by 22 publications

References 13 publications

Vertebral Compression Fractures: Third-Generation Dual-Energy CT for Detection of Bone Marrow Edema at Visual and Quantitative Analyses

Vertebral Compression Fractures: Third-Generation Dual-Energy CT for Detection of Bone Marrow Edema at Visual and Quantitative Analyses

A quantitative assessment of dual energy computed tomography‐based material decomposition for imaging bone marrow edema associated with acute knee injury

Inflammatory Bowel Diseases and Coexisting Spondyloarthritis: A Neglected and too Often Under-Reported Association by Radiologists. A Multicenter Study by Italian Research Group of Imaging in Rheumatology

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